CMS Clarifies Payment Criteria for Remote Chronic Disease Care

July 6, 2015 in News

Last week, CMS released a proposed outpatient payment rule for 2016 that clarifies the requirements health care providers must meet to be reimbursed for remote visits with patients with chronic illnesses, MobiHealthNews reports.


At the start of 2015, CMS began reimbursing Medicare providers under a new billing code, called Chronic Care Management, for care provided remotely and between visits. To use the billing code, CMS required:

  • Treated patients to have at least two chronic conditions;  
  • The provider to create a comprehensive care plan for the patient; and
  • Remote care to account for at least 20 minutes of staff time per month.

Proposed Rule Details

The new proposed rule aims to clarify the use of the CCM billing code based on feedback and questions CMS has received (Dolan, MobiHealthNews, 7/2).

Among other things, the proposed rule would require hospitals to:

  • Have “established relationships” with the patient, meaning provided in-person care within the last 12 months; and
  • Provide “enhanced opportunities” for patient or caregiver to contact the provider (Tahir et al., “Morning eHealth,” Politico, 7/2).

CMS also clarified that only one hospital per patient could be reimbursed for these services each month (MobiHealthNews, 7/2).

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